knee Flashcards
symptoms of meniscal tear
Pain
Swelling
Stiffness
Restricted range of motion
Locking of the knee
Instability or the knee “giving way”
Pain may be referred to the hip or lower back.
tenderness
swelling
special tests for meniscal tear
mcmurrays
thassalys
patient needs knee xray to exclude differentials if
age 55 or above
patella tenderness only
fibular head tenderness
cannot flex the knee to 90 degrees
cannot weight bear
investigations for menischal tear
MRI scan most sensitive
athroscopy gold standard
conservative mangement of most acute soft tissue injuries including knee
RICE
rest
ice
compression
elevation
management of meniscal tear
NSAIDs
physiotherapy- most important
surgery for repair of meniscus or resection of affected portion of meniscus. not many are good for repair
what is the more common cruciate ligament injury to occur
anterior. quite common particularly among athletes
the PCL stops the tibia from
sliding backwards in relation to the femur
the ACL stops the tibia from
sliding forward in relation to the femur
symptoms of ACL injury
pain, immediate swelling, pop sound or sensation
can walk in straight line
bad twisting and turning
deep pain
acl is caused by
twisting injury
females more than males
acl injury tests and investigations
anterior drawer test
lachmanns test
pivot shift
xray
MRI scan first line
often can have lateral meniscal tear simultaneously, sometimes medial
arthroscopy
management acl injury
RICE
NSAIDs
curtches
physio
focused quadriceps programme
arthroscopic surgery- reconstruction, new ligament formed using a graft from another tendon usually hamstring
delayed has better results
bakers cyst
politeal cyst
due to degenerative changes
caused by meniscal tears, osteoarthritis, knee injury, inflammatory arthritis
presentation of bakers cyst
Pain or discomfort in popliteal fossa
Fullness
Pressure
A palpable lump or swelling- most apparent when standing
Restricted range of motion in the knee (with larger cysts)
ruptured- pain swelling and erythema in surrounding tissues and calf muscles
investigations bakers cyst
US first line
MRI
treatment for bakers cysts
nothing fro asymptomatic
modified activity
NSAIDs
physio
aspiration
steroid injections
arthroscopic procedures to treat underlying knee conditions
cause of meniscal tear
twisting esp in deep flexion
osteoarthritis
medial more common!
types of meniscal tear
flap
radial
degenerative
parrots beak
bucket handle
MCL tear
most common ligament tear of knee
severe valgus stress, usually contact related
presentation of MCL tear
heard a pop or crack
intense pain on medial side
bruising medial knee
unable to carry on
localised swelling
tender medial joint line
painful in full extension
investigations MCL tear
x ray to exclude bony injury
mri modality of choice
assess location and severity of injury
MCL management
rest, nsaids
physio
brace for comfort
even in athletes
small number of cases get surgery if non operative is failed, usually has other injuries too
osteochondritis dissecans
unsure of cause
affects articular cartilage and subchondral bone
can be juvenile or adult
knee most common
hereditary
traumatic
vascular
presentation osteochondritis dissecans
activity related pain
recurrent effusions
locking
block to full movement
may have normal history
tenderness
stiffness
wilsons test internally rotate
osteochondritis dissecans investigations
x ray
add in tunnel view
MRI shows status of cartilage and subchondral bone
